Usefulness of standard computed tomography pulmonary angiography performed for acute pulmonary embolism for identification of chronic thromboembolic pulmonary hypertension
| Autor: | Lilian J. Meijboom, Menno V. Huisman, Ludo F. M. Beenen, Gudula J. A. M. Boon, Esther J. Nossent, Lucia J.M. Kroft, Frederikus A. Klok, Harm Jan Bogaard, Petr Symersky, Anton Vonk Noordegraaf, Saskia Middeldorp, Yvonne M. Ende-Verhaar |
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| Přispěvatelé: | Pulmonary medicine, Radiology and nuclear medicine, Cardio-thoracic surgery, ACS - Pulmonary hypertension & thrombosis, APH - Quality of Care, ANS - Neurovascular Disorders, ACS - Microcirculation, Graduate School, Radiology and Nuclear Medicine, AGEM - Re-generation and cancer of the digestive system, AGEM - Digestive immunity, Vascular Medicine, ARD - Amsterdam Reproduction and Development |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty pulmonary embolism chronic Computed Tomography Angiography diagnosis Hypertension Pulmonary CT pulmonary angiography 030204 cardiovascular system & hematology Muscle hypertrophy 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine.artery medicine Pulmonary angiography Humans Interventricular septum Prospective Studies Aged Transplantation accuracy business.industry Reproducibility of Results Middle Aged medicine.disease Pulmonary hypertension Confidence interval Pulmonary embolism thromboembolic pulmonary hypertension medicine.anatomical_structure 030228 respiratory system Pulmonary artery Acute Disease Chronic Disease Surgery Female Radiology Cardiology and Cardiovascular Medicine Bronchial artery business Pulmonary Embolism |
| Zdroj: | Journal of Heart and Lung Transplantation, 38(7), 731-738. Elsevier USA Journal of heart and lung transplantation, 38(7), 731-738. Elsevier USA Ende-Verhaar, Y M, Meijboom, L J, Kroft, L J M, Beenen, L F M, Boon, G J A M, Middeldorp, S, Nossent, E J, Symersky, P, Huisman, M V, Bogaard, H J, Vonk Noordegraaf, A & Klok, F A 2019, ' Usefulness of standard computed tomography pulmonary angiography performed for acute pulmonary embolism for identification of chronic thromboembolic pulmonary hypertension : results of the InShape III study ', Journal of Heart and Lung Transplantation, vol. 38, no. 7, pp. 731-738 . https://doi.org/10.1016/j.healun.2019.03.003 Journal of Heart and Lung Transplantation, 38(7), 731-738. ELSEVIER SCIENCE INC |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2019.03.003 |
| Popis: | BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is often diagnosed after a long delay, even though signs may already be present on the computed tomography pulmonary angiogram (CTPA) used to diagnose a preceding acute pulmonary embolism (PE). In this setting of suspected acute PE, we evaluated the diagnostic accuracy of dedicated CTPA reading for the diagnosis of already existing CTEPH.METHODS: Three blinded expert radiologists scored radiologic signs of CTEPH on initial CTPA scans with confirmed acute PE in 50 patients who were subsequently diagnosed with CTEPH during follow-up (cases), and in 50 patients in whom sequential echocardiograms performed >2 years after the acute PE diagnosis did not show any signs of pulmonary hypertension (controls). All 50 control index CTPA scans had signs of right ventricular (RV) overload. Sensitivity and specificity of expert CTPA reading was calculated, and best-predicting radiologic parameters were identified.RESULTS: The overall expert reading yielded a sensitivity of 72% (95% confidence interval [CI] 58%-84%) and a specificity of 94% (95% CI 83%-99%) for CTEPH diagnosis. Multivariate analysis identified 6 radiologic parameters as independent predictors: intravascular webs; pulmonary artery retraction or dilatation; bronchial artery dilatation; right ventricular (RV) hypertrophy; and interventricular septum flattening. The presence of 3 or more these parameters was associated with a sensitivity of 70% (95% CI 55%-82%), a specificity of 96% (95% CI 86%-100%), and a c-statistic of 0.92.CONCLUSIONS: Standardized reading of CTPA scans performed for acute PE can be useful for the diagnosis of CTEPH when structured identification of 6 characteristics is employed during interpretation. The use of this strategy may help reduce diagnostic delay of CTEPH. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved. |
| Databáze: | OpenAIRE |
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